The Obstacle Is The Way

This blog post was inspired by Ryan Holiday’s book, The Obstacle Is The Way, which describes how employing the philosophy of Stoicism can turn our ‘trials into triumphs’.

This book got me thinking about how we approach issues such as sporting injuries, chronic pain and loss of function that we see in the clinic.

Obstacles such as chronic pain are becoming more prevalent in Australia, with one in five adults reporting they suffer with moderate to severe pain everyday.

It is clear, as a rehab community, we are collectively not doing a great job at helping.

The longer I work as a physio, the more I see how the right mindset and beliefs are a key factor in recovery.

Reading more about the Stoic philosophy, I could see how my values as a health care practitioner aligned closely with with this approach.

The average person has about 50,000 thoughts per day, and for someone who is in chronic pain, you could imagine a large percentage of those thoughts could be centered around these three questions:

• what is going on?

• how is this going to get better?

• when is this going to get better?

When they experience injuries, it’s common for athlete’s (even weekend warriors) to feel anxious and depressed.

One study of 343 male college athletes found that 51 percent had some symptoms of depression after being injured.

Addressing beliefs and attitudes early on can provide the foundation to a successful return to full function.

Downward Spiral Of Injury

We know that a previous injury is the biggest risk factor for another injury.

And that means as a rehab community, we have some work to go in terms of educating and providing injured people a comprehensive rehabilitation program in order to prevent compensations and further issues.

Without inadequate rehab, a downward spiral of pain and injury can develop, eventually leading to burnout.

Stoicism - a little background

Getting back on topic!

Stoic philosophy was founded in Athens in the early 3rd century BC, and was practiced by the likes of Epictetus, Seneca and Marcus Aurelius.

Ryan Holiday writes specifically of being inspired by Marcus Aurelius, whose quote inspired the book:

“The impediment to action advances action.

What stands in the way becomes the way.”

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Marcus Aurelius, as well as being one of the most successful Roman Emperors, had his own private struggles with chronic pain in the chest and stomach.

His personal notes practicing Stoic philosophy, The Meditations, refers many times to psychological strategies for coping with pain and illness.

His physical resilience and endurance was remarkable, despite not having ideal physical health he was to become one of the most respected emperors in Roman history.

Mindset Shift

One of the biggest lessons taught by the Stoics was to re-conceptualise your obstacles from something to avoid to something to welcome, as a means of growing stronger and more resilient.

Obstacles give you important clues as to where you may have some ‘weak links’ and provides an opportunity to turn them into strengths.

Following a Stoic philosophy involves re-wiring your thinking, shifting from negative emotions such as from worry, anger and frustration to calmness, gratitude and hope.

To be clear, negative emotions can be healthy and natural.

But at some point, they become more of a hindrance to your forward progress.

With the right plan in place, and plenty of patience, grit and perseverance according to leading sports scientist Tim Gabbett, you can turn yourself into an unbreakable athlete. 

“It is a rough road that leads to the heights of greatness” - Seneca

Short Term Pain Coping Strategies

Of course if your only goal is to avoid pain, there are some strategies that can bring about some fast relief.

Using pain-relieving medication has it’s time and place.

But unfortunately we’ve seen the long term consequences of opioid medications (e.g. tramadol, oxycontin and codeine) that can sometimes lead to addiction and other serious side effects.

And we now know from the research that these drugs create a long-term increased pain sensitivity, making your pain levels greater than before you started taking them.

The other problem is once you come off the medications, you haven’t any had an opportunity to learn from your pain and injuries, so you essentially need to start all over again.

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Instead of relying on pain medications, here’s eight practical strategies, inspired by the Stoic Philosophers, over 2000 years ago, to help you overcome your pain and live the best life you possibly can:

1. Accept Pain And Injuries 100%

The Stoic philosophers were big on understanding the rhythms of nature.

Just like stormy weather, it would unwise and naive to believe you would never have a pain or flare-up in your body.

No one gets out of life without serious challenges along the way and no one is immune to experiencing pain.

However, the difference lies in how we perceive and respond to it.

A real life example world would be to consider how a sailing boat gets from point A to point B if there is a direct headwind blowing in their direction?

Would the sailor just give up and think it’s not worth the hassle?

The experienced sailor would no doubt accept that unfavourable winds are going to happen some of the time - that is a normal part of life, and they wouldn’t get overly emotional when it occurs.

For the sailor who is committed to reaching point B, the solution, is to change tack.

If the boat turns onto a 45 degree angle, then the sails are able to pick up the wind and use it to the boats advantage.

Progress is no doubt slow and frustrating, but it is still forward momentum and getting you closer towards your goal.

When the winds eventually turn favourably, you would have built up a decent reserve of resilience and capacity.

Bottom line: there is a season for pain and it is a normal and inevitable part of life.

Keep breathing, batten down the hatches if necessary.

The storm will pass.

2. Let Go Of Your Fight Against Pain

Following on from the first point, counter-intuitively, to overcome your pain, you must be at peace with your pain and fully accept it.

The struggle, the fight and the mental battle against your pain only ends up wasting precious energy and resources, that could otherwise be better spent.

Being trapped in a state of resistance and anxiety leads to your body into a fight or flight mode where your muscles are held in a constant state of tension.

This can lead to even more problems than your initial injury.

Common muscles that are involved in the fight / flight response are:

• neck / trapezius

• hip flexors

• lower back

• TMJ jaw

• shoulders

Once you can find acceptance, a significant burden is literally lifted from your shoulders.

With the guidance of a health care professional, it’s important to let go of your anxiety and find a place inside that is relaxed.

“Sometimes, your only way out of the pain is through the pain”

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3. Imagine The Worst Case Scenario

The Stoics proposed, rather than avoiding the pain, we must accept it and then confront it.

Once you are feeling more relaxed and in control of your emotions, Stoicism actually encourages you to imagine the worst case scenario in terms of your pain experience.

If you could courageously come to terms with the worst case scenario - and see how, while it would be difficult, you would definitely still be able to cope.

Practicing this exercise mindfully can help reduce the fear around pain, injury and loss of function, knowing that you will be able to manage, no matter how bad things get.

4. Good vs Bad?

Injuries can often be thought of as ‘bad’.

But are they really?

This reminds me a of a story about a farmer.

One day his horse runs away. And his neighbor comes over and says, to commiserate, “I’m so sorry about your horse.” And the farmer says “Who Knows What’s Good or Bad?”. The neighbor is confused because this is clearly terrible. The horse is the most valuable thing he owns.

But the horse comes back the next day and he brings with him 12 feral horses. The neighbor comes back over to celebrate, “Congratulations on your great fortune!” And the farmer replies again: “Who Knows What’s Good or Bad?”

And the next day the farmer’s son is taming one of the wild horses and he’s thrown and breaks his leg. The neighbor comes back over, “I’m so sorry about your son.” The farmer repeats: “Who Knows What’s Good or Bad?”

Sure enough, the next day the army comes through their village and is conscripting able-bodied young men to go and fight in war, but the son is spared because of his broken leg.

And this story can go on and on like that. Good. Bad. Who knows?

Be at peace with your path and have faith that everything happens for a reason.

There is no good or bad to the practicing Stoic, there is only perception.

5. Switch From Goal Oriented To Process Oriented

While you can learn the principles of Stoicism, the philosophy is actually one of action.

A Stoic needs to focus his attention on action in the present moment of time because neither the past nor the future can be changed.

Being process orientated, you start to focus on all of the small daily things you need to do that all add up to produce the end result.

Come back to the present moment.

That is where the power is to change your life for the better.

Take the focus off being pain-free and instead put your focus on the process.

What are the small daily tasks you need to do to become pain free?

“Luck is what happens when preparation meets opportunity.” ― Seneca

6. Understand Your Pain

“We are more often frightened than hurt; and we suffer more in imagination than in reality.” – Seneca

There is no doubt that ongoing pain that is unexplained can be frightening.

With the help of your Physio and Doctor, if you can understand that some degree of pain is a normal part of the healing process, you can relax in that knowledge.

It’s important to realise that whatever pain you experience should be related to a certain physiological process.

For example:

Ankle sprain —> inflammation around the ligament, you can expect some soreness for 4-6 weeks

Lower Back pain —> occasional flare-ups, especially if sitting too long. Disc injury takes around 3 months to heal

Tendon degeneration —> worst in the morning and with sudden changes in training volume, hills or speed work

Knee - patello-femoral syndrome —> (pain in front of the knee cap) take on average 3 months to get better and pain relates to irritation behind the knee cap and gets worse with squats, kneeling and stairs

Nerve related irritation or damage —> could be many months or years of altered sensation in the affected area

Muscle pain —> the most common source of musculo-skeletal pain - lack of oxygen to the muscle from poor posture, excess muscle tightness or injury.

Chronic pain (more than 6 months) —> relates to increased sensitivity in the nervous system which magnifies minor tissue problems. It may come down to the fact, that we all have wear and tear and issues in our body, for whatever reason, the body and nervous system has decided to heavily focus on that particular area.

If there is ongoing pain and you are not sure why, then you may need to talk to your health care provider in more detail.

7. Develop A Growth Mindset

Stoic philosophy has a lot in common with the Growth Mindset approach, developed by Carol Dweck.

According to this approach, the most important word in the dictionary is ‘yet’.

Re-frame your challenges…

“I haven’t completed the marathon…yet”

“I haven’t felt strong and pain-free in my lower back…yet”

“I’m not sure what it feels like to walk without pain…yet”

8. Train Your Mind To Endure Pain And Discomfort

It takes practice to exhibit self-control with our perceptions of life’s obstacles.

You can practice - the next time your stub your toe or get a paper cut.

Pause for a moment and see if you can absorb the sensation of discomfort - without reacting to it.

One of the great things about exercise is that it is a form of discipline where you willingly put yourself in a position of discomfort for a period of time, with the hope that you will come out the other side better off physically or more importantly mentally afterwards.

As you practice pushing yourself to the threshold, you will build a reserve of willpower to draw from as necessary, creating a “Inner Citadel” of strength and resilience.

For me personally, that is one of the reasons I enjoy the process of running so much.

Every time I go for a run, I know I will confront the pain of a body wanting to stop.

To achieve any sort of reasonable time, you need to learn to listen to your bodies pain, but constantly re-directing your attention and keep pushing to achieve your goal.

“Faced with pain, you will discover the power of endurance” - Epictetus

Conclusion

Pain and injuries are never easy.

But with the right attitude, they can be an valuable internal guide to making you better and stronger than before.

What seem like insurmountable obstacles become once in a lifetime opportunities.

If you’d like to find out more about Stoic philosophy, I’d highly recommend you check out the book, The Obstacle Is The Way.

Now it’s over to you,

What’s the biggest obstacle you’ve faced? What benefits were you able to derive from it?

I’d love to hear your thoughts in the comments section below.

The Power Of Plasticity - Helping You Move Better - Part 2

The Power Of Plasticity - Helping You Move Better - Part 2

In Part 1 we talked about the power of neuro-plasticity and how it can work positively or negatively to affect your movement.

To summarize what we have learnt so far:

Dysfunctional Pain / Injury Cycle:

Ideal Pain / Rehab Cycle:

Pain changes the way we move

Research has clearly shown that people who are in pain change the way they move.

We see that people who are in pain (especially as it becomes more chronic):

• move with less range of movement

• move more slowly

• have less variety of movement patterns available

• show higher levels of muscle activity compared to people without pain

Muscle memory forms around these patterns and even though the injury often has healed (3 months average), you are left with changes in the way your body functions.

While these changes are obvious from a physical perspective, in order to get a full and accurate picture about what is going on, we need to take a broader view and see the bigger picture.

A shift in focus

The relationship between pain and the tissues becomes less clear the longer pain goes on (see picture below).

Credit: Explain Pain (Butler & Mosely)

As pain persists, we must consider the nervous system, and the plasticity that occurs around it.

When you have chronic musculo-skeletal pain, the two main issues from a nervous system perspective are:

• altered body representation in the body maps in the brain (smudging)

• reduced movement pattern availability (due to protection systems / fear of movement causing more damage).

Getting Personal

The best outcome will be when the clinician can spend a decent amount of time with someone in the beginning (at least one hour) to individually assess and determine an appropriate plan of attack to help the neuro-muscular system return to state of harmony.

One way to describe this approach is incorporating a top down (neurological based) and a bottom-up (local tissue) approach.

If you’ve been struggling with an ongoing pain issue, there is good news. A large body of research shows the more you can understand about the nervous system and why you’re in pain, the more likely you’re going to make a full recovery. I’d highly encourage you to talk to your local Physio or GP about some specific resources that can help you in your journey.

In Part 2 of the blog, we go into depth about how to optimise your lifestyle to enhance the effects of neuro-plasticity and reach your movement potential.

I hope you find it useful, (and I welcome your questions in the comments below).

1. Aerobic Exercise

I like to think of changing our neuro-muscular habits as similar to the process of creating glass.

Sand is heated up to very high temperature, and then molded and then left to set in a certain desired shape.

The most important part of this process is the heating, where the sand becomes malleable, pliable and able to be worked into a particular shape.

Without the heat, there is a stiff, solid structure with no ability to change.

Our brains and bodies work in a similar way.

In terms of changing our neuro-muscular patterns, aerobic exercise is what creates a similar heat-like environment for creating brain/movement plasticity.

Aerobic exercise (especially running) has shown to strongly increase blood flow to the brain, decreasing inflammation and even stimulating new brain cell growth through the expression of neurotrophic factors (such as BDNF and IGF-1).

Physical exercise facilitates neuroplasticity

An article by Hottling and Roder in Neuroscience and Behavioural Reviews explains the benefits of physical exercise on neuroplasticity.

The authors conclude that increase in cardiovascular fitness has significant neurocognitive benefits.

The hardest part is to begin

If you haven’t moved much for months or years due to pain or general inactivity, your ability to re-wire your movement becomes much more limited.

If you’re already in pain and find movement difficult, a downward spiral can quickly unravel (see picture above).

Getting moving can be tough, but just remember, 90% of the fuel is to get the rocket off the ground is used in the first 2 minutes.

Breaking through movement inertia is hard work, but once you get going, things get much easier and you have made the most important first step in feeling better again.

Guidelines for aerobic exercise if you’re in pain:.

• Find something you enjoy and that you could maybe do with a friend to keep you accountable

• Start with an easy level (less than 5/10 intensity) You should be able to talk to a friend at your easy pace

• Pace yourself. Take short breaks as you need to before you get fatigued

• Monitor your 24 hour response and progress gradually as you can

• Set up a positive reward immediately following - a nice healthy meal or watch your TV show

• Make it fun and playful

• Listen to your favourite music or podcast

I would recommend, if you are trying to improve your neuro-muscular patterns, that you spend at least 30-60 minutes per day engaged in low-moderate intensity exercise.

Running stimulates neuro-plasticity

Running deserves a special mention here because I think the process of learning to run can be one of the best things you can invest your time in, in terms of building your foundation through neuro-plasticity.

One of the great things about running, (providing you can learn to listen to your body), is that it gives you ongoing feedback to where your weak links are.

For example, you might be out running and you feel your hip getting tight. After your run, you focus on some specific hip stretching and release exercises. The next you run, your hip feels great.

And then you get a bit quicker and can longer, but then your hamstring starts playing up. Once again you go back and do some hamstring strengthening and once again return to running more resilient and stronger than before.

This process can take weeks, months or years, so patience is required. But always keep in mind where you started from and seeing the progress you are making should be enough motivation to fuel your onward progress.

One of the other great thing about running is the concrete goals you can set and build towards such as 5k Park runs, 10km community events or marathons in exotic locations around the world.

There is an amazing running community that can help support you also.

2. Food

The four most outstanding foods for increasing neuro-plasticity are blueberries (high in flavinoids and anti-oxidants), omega-3 fatty acids, green tea and curcumin (found in turmeric). It’s worth considering making these a part of your regular diet.

An abundance of fresh vegetables and fruits

The best vegetables are those that are non-starchy (low carbohydrate content) with high amounts of fiber. Fiber gives us a “full” feeling and keeps the intestinal tract moving. Low glycemic fresh fruits, fresh vegetables in salads and cooked vegetables should provide the bulk of the food in an optimal neuro-plasticity diet.

Protein

Re-building neuro-muscular patterns requires additional protein, compared with a sedentary person.

The timing of the protein is also critical, with research showing that evenly spreading your protein over 3 or 4 meals during the day creates the best environment for recovery and re-building.

High quality fats
Healthy fats make up a critical part of a good neuro-plasticity diet (the brain consists of nearly 60% fat).

These include:

• omega-3s (from high quality fish high in omega-3s, flaxseed, grass-fed beef, eggs)

• monosaturated fats (from extra virgin olive oil, avocadoes, nuts, and seeds)

• medium chain triglycerides (from extra virgin coconut oil)

• saturated fat from (grass-fed meat, eggs and milk, yogurt, cheese)

Coconut oil excels as cooking oil, for it doesn’t oxidize at high temperatures. Cooking with butter, or even better with clarified butter (called ghee in India) is another safe alternative to vegetable oils that go off at even low heat.

Reducing unhealthy fats especially trans fats and most vegetable oils except extra virgin olive oil is important.

Low sugar and carbohydrate intake
Fruits with a high fructose content are best eaten sparingly in a healthy neuro-plasticity diet.

These include:

• mangoes, peaches, pineapple, plums and grapes.

• fruit juice is equal to soft drink in sugar content so should be avoided if possible

3. Sleep

Getting enough sleep is a critical part of creating optimal neuro-plasticity.

Research shows adequate, quality sleep and synaptic plasticity are strongly related.

Your brain needs sleep to reset brain connections that are important for memory and learning.

If sleep is an issue for you, SA Health have a useful guidebook you can download here

4. Positivity and Self-Belief

“Beliefs create biology” - Norman Cousins

When you’re find yourself in pain, one thing you have to commit to is not allowing yourself to entertain negativity in your life.

Repeating a few key positive words or mantras to yourself can help you work through a rough patch.

Some of my favourites include:

“My spine is strong and resilient'“

“This is like a storm, it will pass, I’ve just got to get take some extra care of myself until it passes”

“Wounded but not conquered”

“Motion is lotion”

Part of being positive is to have realistic expectations and to expect set backs and a non-linear recovery.

5. Variety of Movement Wins

People who are in pain, often describe they feel like they are moving like a robot.

They get ‘stuck’ in a certain pattern and can have a tough time breaking free, as well as adapting to their environment.

Creating new movement patterns is like learning new chords on a guitar.

The more chords you know, the better your music will sound.

How do we develop Movement Programs?

If you ever saw the movie, The Matrix, you may remember when Neo ‘learns’ how to do kung-fu in a matter of seconds via an upload to his brain.

While science fiction now, the principles are the same. We need to upload the appropriate movement patterns and skills that are going to give us the best chance of achieving success.

The difference is that motor learning and skill formation takes a little longer in real life compared with a few seconds in the movies!

The initial process of learning and practicing a skill can be very mentally taxing.

Author Malcolm Gladwell stated around 10,000 hours was needed to develop high level of skill and used the example of the Beatles, in the early 1960’s, played in Hamburg where they played 5 hours per night for 270 nights over a couple of years. That intense level of practice turned them into the success they were.

If 10,000 hours seems a bit far-fetched, there is good news.

Researches believe, to install a new pattern or habit, you simply must practice it sixty times every day for 21 days in a row.

In terms of movement, this sounds very achievable.

For example if you’ve got a sore your back, you may have lost the movement patterns of:

• pelvic tilting

• hip hinge

• squatting

If I get you to practice these movements everyday, you will start to re-groove these patterns back into your body/mind, and soon they will be stored sub-consciously, ready to use during the day when needed.

The more variety of movement patterns you have available and online ready to use, the more the load is spread evenly through the body, not always relying on the same pathway to get the job done.

6. Dry Needling / Massage

We know dry needling works by increasing blood flow and directly improving the flexibility of the muscles.

However, some new research is coming out showing dry needling improves kinesthetic sense and effects helps to sharpen the sensory homunculus, leading to improved awareness, flexibility and joint range of motion.

This study showed how needling can re-wire the somato-sensory cortex (body maps) in the brain with people with carpal tunnel syndrome. The research suggest that improvements in primary somatosensory cortex sharpness can predict long-term clinical outcomes for carpal tunnel syndrome.

Studies have shown that dry needling also increases the release of nerve growth factor, which aids in rewiring the brain for improved motor patterning and decreasing the loss of brain smudging to areas of chronic pain.

There is a lot of research still to be done and it must be stressed this is still in the speculative stage. However, to me this line of thinking is very plausible and opens up an exciting frontier for the all rehabilitation professionals.

The ability for the needle to get in the deep parts of the muscle provides a significant sensory stimulation that can help create improved movement efficiency and awareness.

Massage and foam rolling can also have a similar effect, although more superficially.

7. Relaxation / Recovery

Stress is one of the main factors that decreases neuro-plasticity in the adult brain.

Cortisol is one of the chemicals that chronic stress can produce and makes forming new synaptic connections very difficult.

When you’ve had a pain or injury, our default mode is often fear and anxiety and this can lead to being constantly on the look out for potential threats (real or perceived) that could disturb our safety.

Going through a traumatic event, (or repeated mental, physical or emotional trauma over many years) can create a deep neural pattern of self-protection.

This can look like constant muscle tension / guarding and severe physical de-conditioning over many years.

Everyone is different, but learning to get your body back into a relaxed state (para-sympathetic) is a really important part of your healing.

It could involve things like:

• relaxing warm bath

• hike in nature

• going for a swim or surf

• restorative yoga class

• getting a massage

• deep breathing exercises

• talking with a friend

• going to the movies

• knowledge can be empowering and educating yourself about your body and the pain process can be a liberating experience

Try and make a list of things that relax you and schedule them into your week ahead of time.

8. Tips to Improve Body Maps

• Movements that are most likely to lead to changes in the quality of the maps are movements that are different, interesting, rich in sensory input, slow, gentle, mindful and non-painful.

• Walk barefoot on the grass and feel your foot moving on the ground

• Roll a spikey ball under your foot

• Watch your favourite athlete move

• Tai chi, Pilates, Feldenkrais, Somatic therapy, Alexander therapy and yoga are all recommended

Mirror Neurons

Have you ever wondered why your tennis game suddenly improves after you’ve watched two weeks straight of the Australian Open?

Welcome to the world of mirror neurons.

When we watch someone else doing something – swimming, picking up a newspaper, eating – we also simulate with the body maps in our brains what it might feel like for us to be doing those same things.

Personally, I find the night before a run, watching some youtube clips of elite runners helps get in the zone.

For runners, I’d highly recommend:

For tennis players:

For footy lovers:

Take Home Messages:

• The body grows best when it is challenged and stressed at the right rate with the right conditions (exercise, diet, sleep, recovery).

• Change takes time and to build and re-wire new movement patterns takes, at minimum 3 months, on average 12 months.

• Considering a top-down (neurologically brain-based) and a bottom-up approach (local muscular level) can bring about some dramatic shifts in how we go out understanding how to move better.

• Patients must be treated on an individual basis, and clinicians should target both mechanical and neurological deficits as they are indicated for a particular person.

• If you can harness the power of your mind, you can achieve things you may never though possible and surpass limitations that have been holding you back.

• Hopefully this blog post will help you think beyond the muscles, joints, and ligaments to what is happening in the nervous system to improve your movement.

If you’ve made it this far into the blog post, a big congratulations!

I know it’s been a long haul and I apologise for not being more articulate in my message.

The fact is I think about these things a lot, and trying to communicate this information in a brief 1:1 Physio consultation just isn’t possible.

Please let me know if you’ve found any of this useful in the comments below.

Recommended Reading:

• The Brain that Changes Itself, Norman Doidge

• All About Running: Synaptic Plasticity, Growth Factors and Adult Hippo campal Neurogenesis

• It is not just the brain that changes itself – time to embrace bioplasticity?

• Rewiring the primary somatosensory cortex in carpal tunnel

• Smudging of the Motor Cortex Is Related to the Severity of Low Back Pain

• Smudging the motor brain in young adults with recurrent low back pain.

• Disrupted Tactile Acuity in People With Achilles Tendinopathy

• Primary Motor Cortex Organization Is Altered in Persistent Patellofemoral Pain

• Alteration in global motor strategy following lateral ankle sprain

Introducing, KIN Foundation (Physio Group Class):

KIN Foundation Pilates is designed to truly encompass a top down (neuroplastic) and a bottom up (physical movement) based approach to therapy.

KIN is an acronym for:

• Kinesthetic (optimising sensory input to sharpen body maps in the brain)

• Integrative (having uniting and positive effect on all systems of the body)

• Neuro-muscular (fine tuning the muscle-brain connection for optimal movement efficiency)

Build strength, stability and the foundation to promote vibrant health. 

LINK for all the details

The Power Of Plasticity - Helping You Move Better - Part 1

"We are all sculptors and painters.  Our material is our own flesh, blood and bones." - Henry David Thoreau

This post takes a look at why we move the way we do, and how we can tap into the 'Power Of Plasticity' to start moving (and feeling) well again.

Warning: This post is long.

As the New Year ticks over, many of us find ourselves reflecting on our health and making some goals for the year ahead.

I can understand you may be reluctant to set a new years resolution.

But from the body’s view point, it desperately needs a goal to work towards.

It needs direction, positive growth, a challenge and a reason to get out of bed in the morning.

Your goal might be a run a marathon. Or it could be taking a challenging hike. Or spending the day in the garden.

Whatever it is, it should be something you enjoy and something that will motivate you to get you moving more often.

As soon as you become complacent about your body and your health, it can lead to a downward spiral of pain, injury and de-conditioning.

In modern day life with our attention being drawn into our devices, internet and netflix we can find ourselves completely out of touch with our bodies.

Months or years can easily slip by and all of a sudden we can find ourselves in a ‘movement rut’.

“Change is the only constant in life” - Heraclitus

Whether we are conscious of it or not, the body is always changing and adapting to the stresses we put it under.

From our bodies perspective you are either growing or stagnating.

There’s not much middle ground.

Plasticity: the adaptability of an organism to changes in its environment

That continual growth or stagnation that takes place is also known as plasticity.

As humans, we are highly adaptable and this can be a very positive thing.

The entire body is capable of plasticity

Professor Lorimer Mosely, from the University of South Australia, writes:

All our body systems respond to demand – in obvious ways such as:

• growing muscle cells when we lift weights – myoplasticity

• sweating more when we acclimatise – endoplasticity

• learning to recognise a pathogen and eliminating it on next contact – immunoplasticity

• increasing our heart-rate earlier on a hill after running up it a few times – cardioplasticity

• adjusting the aperture of our pupil to improve our underwater vision – obiculoplasticity

• the toughening of skin on well trodden heels – dermoplasticity.

In fact the body that you have today, is different is quite a bit different to the body you had a few days/weeks/years ago.

Regeneration Speeds Of The Human Body:

“The body is a powerful healing machine” - Kelly Starrett

These info-graphs refer to how our body parts are under a constant state of repair and regeneration (plasticity).

I’m not sure about you, but I find this knowledge really empowering and inspiring.

If you are in a difficult place right now, keep the faith and stick it out.

“Everything will be okay in the end. If it's not okay, it's not the end”. - John Lennon

With the right guidance and plan in place, good times are ahead for you.

If you can harness the power of positive plasticity you can get stronger, more resilient and eventually become pain-free.

Movement and Neuro-plasticity

This blog post is mainly focused on the neurological and muscular plasticity that happens in the body in response to movement.

We will take a look at how the healthy brain-body system operates when it’s fully “connected,” and conversely, what happens when things become dysfunctional.

Body Maps In The Brain

In many ways, our understanding of the brain has only just begun.

One of the most exciting developments in the 20th century was the identification of ‘body-maps’ in the brain.

The body maps refer to two of the principal areas in the brain involved in movement.

These include:

1. The Somato-Sensory Cortex - Encodes the representation of the entire body (i.e. body maps). Representational space correlates with how much a body part is used (i.e. use it or lose it)

2. The Motor Cortex - Generates conscious movement and stores subconscious movement patterns (i.e. muscle memory).

Our Body Maps Are Plastic

Neuroscience research suggests our brains are ‘plastic’ meaning that areas change depending on the amount and quality of use. 

The more time and attention moving a certain body part, will result in a bigger representation of that area in the brain.

For example:

• people who use braille have a larger finger representation in the brain than the average person

• similarly guitar players will have a bigger hand representation in the brain

Body maps (and movement) comes to down to habits

Imagine you’re heading down to Aldinga for a day trip, (which is a beautiful beach an hours drive south of Adelaide, that allows cars onto the sand).

You arrive at the beach and follow the ramp down, driving your car onto the beach.

As you drive along the sand, your car makes tracks in the sand.

You find a nice spot to park the car and get yourself set-up. After you’ve had a swim, you’re feeling refreshed…but then you realise you’ve forgotten to buy some snacks.

So you jump back in the car and as you start driving, you can see the tracks you’ve made earlier.

As the sand is harder under the tracks, it’s easier for your car to move along the same tracks and reduce the likelihood of you getting bogged.

Each time you make a trip along the beach, the tracks get a little deeper and it gets a little easier to drive because the sand gets a little firmer and the track is becoming more worn.

You automatically keep using the same track without even thinking about it.

Using the same track is very similar to what happens with our bodies - the car represents our bodies movement and the tracks represent the neural pathways in our brain.

As our brains begin to use this pathway more, it becomes second nature.

This process of re-wiring the brain and forming new connections is plasticity in action.

Essentially using the same habitual movement patterns over and over again without ever thinking about it.

To create new movement patterns is like carving out a new road.

If you’ve had pain for some time, your body goes into protective mode. Movement expression becomes limited and breaking out of this stereo-typed response is going to take considerable energy, effort and some serious intent.

In an ideal world…

In an ideal world, the brain has a perfectly sharp representation of the body and the brain/body have a variety of quality movement patterns (muscle memory) to handle the demands placed on it.

The body and mind are perfectly synchronised.

An example of this might be watching Roger Federer playing tennis or Eddy Betts playing AFL.

They make highly complex skills look easy and effortless.

Body maps change when you’re in pain

Initially, when you’ve injured yourself or are in pain, the body map representation of the involved area actually gets bigger.

This explains why you may feel an increase in pain sensitivity and mild pains can become magnified.

This is especially true if the body part is very important to you e.g. if you injured your finger if you’re a concert pianist or your knee if you’re a runner.

The Negative Side Of Plasticity - Smudging

Smudging refers to the reduced accuracy of the body maps in the brain that happens when you don’t use a particular area for a period of time.

Smudging can be caused by things like:

• poor posture

• ongoing pain

• injury

• inactivity

More about brain smudging with David Butler:

Smudging of the brain maps, otherwise known as the Homunculus, latin for ‘little person’ in your brain

Credit: Explain Pain (Butler & Mosely)

“Pain and body image are closely related” – Norman Doidge

Studies have shown now that smudging of the body maps is related to the severity of lower back pain.

For example if you have injured your spine and you feel intense pain and muscle spasms for a few weeks, naturally, you may limit the amount of movement you will do for your spine.

Over time, there is less sensory input from the spine to the brain.

With limited input, the brain hasn’t got an accurate sense of what’s happening in the body (smudging of the body maps) and starts to perceives this as a threatening situation.

This is an important point because the pain you feel may not be related exclusively to a structural issue.

The fact is many people have degeneration / wear and tear and have absolutely no pain at all (see the chart below).

Pain, especially as it becomes more chronic, may be more related to changes in the nervous system (specifically the body maps in the brain).

The key point is that physical pain doesn’t necessarily have (only) physical causes.

Credit: Explain Pain (Butler & Mosely)

Key Point: A very large part of the way we move, comes to down the accuracy of our body maps

A large body of evidence shows that pain and injury causes a change in activity in the regions of our brains that control movement.

This is true for things like:

• recurrent lower back pain

• knee pain

• achilles tendon pain

• post ankle sprain

• patello-femoral pain

Everyone has their own unique response to pain and injury and I can’t emphasize enough the importance of getting a personalised movement assessment to find our your own individual patterning.

The first step is becoming aware, and then you can go about re-wiring your neural pathways and re-building your movement foundation.

If you aren’t consciously creating your movement patterns, you are in default mode - where your environment creates and dictates your movement.

Re-building Movement Patterns

“The more richer, the more varied the possibilities of your movement landscapes, the powerful you are” - Michael Merzencich

Back to our person with lower back pain example mentioned earlier.

Through pain and fear of doing more damage, their movement repertoire has become limited.

This results in:

1. A reduced ability to adapt to changes in their environment, leading to a higher chance of re-injury

2. Overload of tissues in the movement patterns that the person feels safe in e.g. they may have been told to always ‘sit up straight’ and the posterior back muscles are in a constant state of tension and activity

The original injury most likely has healed and the person now is dealing with the consequences of the changed movement patterns.

For optimal long term health, gradually adding variability to your movement and posture is a critical skill to learn.

In the world or ergonomics, having a variety of movements trumps locking into a narrow and restricted definition of ‘good posture’.

Creating the right conditions and environment to learn new movement patterns and strategies is what we’ll spend more time discussing this in Part 2 of this blog.

Key Take Home Messages:

• The key to tapping into your bodies potential is neuro-plasticity, the process of creating new neural pathways

• Understanding neuro-plasticity is the most revolutionary discovery of neuroscience in the past century.

• There is great hope for people with chronic pain if you can access the power of movement neuro-plasticity

• “The relationship between pain and the state of the tissues becomes weaker as pain persists” - D Lorimer Mosely

• Widening our treatment approach to integrate the research on neuro-plasticity may be the missing link in helping people with chronic pain conditions

In Part 2 of the blog, we’ll go into depth about how to optimise your lifestyle to enhance and encourage the benefits of movement neuro-plasticity.

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